democratic republic of the congo · in the democratic republic of congo (drc), results from a...

Democratic Republicof the Congo

Demographic and HealthSurvey (DRC-DHS II)

Supplemental Vaccine-preventable Diseases Report

2013-2014

DEMOCRATIC REPUBLIC OF THE CONGO

DEMOGRAPHIC AND HEALTH SURVEY (DRC-DHS II 2013-2014)

Supplemental vaccine-preventable diseases report: A serosurvey of population immunity to measles, rubella, and tetanus among children 6-59 months

August 2015

LA BANQUE MONDIALE

Le Fonds mondialDe lutte contre le sida, la tuberculose et le paludisme

The second Demographic and Health Survey in the Democratic Republic of Congo (DRC-DHS II) was conducted by the Ministry of Monitoring, Planning and Implementation of the Modern Revolution [Ministère du Plan et Suivi de la Mise en oeuvre de la Révolution de la Modernité], in collaboration with the Ministry of Public Health [Ministère de la Santé Publique]. The DRC-DHS II was financed by the government of DRC, the US government through the United States Agency for International Development (USAID) and the President’s Emergency Plan For AIDS Relief (PEPFAR), the Department For International Development (DFID), the World Bank through the Health Sector Rehabilitation Support Project [Projet d’Appui à la Réhabilitation du Secteur de la Santé (PARSS)], the Global Fund through the ASBL Primary Health Care in Rural Areas [Soins de Santé Primaire en milieu Rural] (SANRU), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the University of California Los Angeles (UCLA). Other institutions also provided assistance for the survey, notably the National AIDS and STI Control Program’s Reference Laboratory [Laboratoire National de Référence (LNR) du Programme National de Lutte contre le VIH/Sida et les infections sexuellement transmissibles (PNLS)], The National Institute for Biomedical Research [Institut National de Recherche Biomédicale (INRB)], Family Health International (FHI 360), the Centers for Disease Control and Prevention (CDC) and the University of North Carolina (UNC) for certain biomarker tests. ICF International provided technical assistance to the entire project via the MEASURE DHS project, financed by USAID, which provides support and technical assistance for population and health surveys in countries worldwide. The Kinshasa WHO office also provided logistical support, notably in clearing medical supplies through customs.

Additional information about the DRC-DHS may be obtained from the Ministère du Plan et SMRM, 4155, Rue des Coteaux, Quartier Petit Pont, Kinshasa/Gombe, BP 9378 Kin 1, Kinshasa, E-mail: [email protected].

Information about The DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1 301-407-6500; Fax: +1 301-407-6501; E-mail: [email protected]; Internet: www.DHSprogram.com.

The Supplemental VPD report was prepared by:

Anne Rimoin Reena Doshi Nicole Hoff University of California, Los Angeles Sue Gerber Bill and Melinda Gates Foundation

Emile Okitolonda Patrick Mukadi University of Kinshasa School of Public Health Jean-Jacques Muyembe National Institute of Biomedical Research

Contact information:

Anne W. Rimoin, Ph.D., M.P.H., Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California 90095, USA; Telephone: + 1 310-825-2096; E-mail: [email protected]

Emile Okitolonda Wemakoy, M.D., Ph.D., UCLA-DRC Health Research and Training Program, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo; Telephone: +243 815035270; E-mail: [email protected]

iii

LIST OF TABLES

Table 1 Children 6 to 59 months (de facto) eligible for MMRVT antibody testing according to demographic characteristics (unweighted), Democratic Republic of Congo, 2013-2014 .......... 5

Table 2 Results estimating the presence of measles antibodies............................................................... 5 Table 3 Results estimating the presence of tetanus antibodies ................................................................ 6 Table 4 Results estimating the presence of rubella antibodies ................................................................ 6 Table 5 Results estimating the presence of mumps antibodies ............................................................... 7 Table 6 Results estimating the presence of varicella antibodies ............................................................. 7 Table 7 Results of the test for the presence of measles antibodies and vaccination coverage

among children 6-59 months ...................................................................................................... 8 Table 8 Results of the test for the presence of measles antibodies and vaccination coverage

among children 12-23 months .................................................................................................... 9 Table 9 Results of the test for the presence of tetanus antibodies and vaccination coverage

among children 6-59 months .................................................................................................... 10 Table 10 Results of the test for the presence of tetanus antibodies and vaccination coverage

among children 12-23 months .................................................................................................. 11

1

Childhood vaccine-preventable diseases (VPDs) continue to pose major public health problems in terms of global morbidity and mortality. In the Democratic Republic of Congo (DRC), results from a recent national EPI Cluster Survey in May 2012 suggest that routine vaccination coverage varies widely by province. Independent monitoring and post-campaign evaluations confirm that there are still many children with zero or incomplete doses of routine vaccinations1,2,3. Currently available sources of vaccination coverage data, including administrative reports from the National Expanded Programme on Immunization (EPI), WHO/UNICEF coverage estimates, and national household surveys—including Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), and Immunization Cluster Surveys—have traditionally been based on vaccination records that are often unavailable and incomplete or maternal recall, which is known to be biased4,5,6. In the 2013 DHS, vaccination cards were seen in only 26% of cases. Furthermore, these estimates do not reflect population immunity, which can be affected by multiple factors.

Prolonged interruptions in vaccination activities due to conflict and unrest over the last decade may have resulted in significant immunity gaps in older children and adults, potentially leaving entire cohorts susceptible to vaccine-preventable diseases. Poor infrastructure and difficult terrain isolate many villages in DRC, making vaccine delivery, supply, and storage under proper conditions difficult. Therefore, vaccine efficacy may be compromised, resulting in sub-optimal immunity at both the individual and population levels.

DRC has seen a number of large-scale measles outbreaks throughout the last decade; measles continues to be one of the largest causes of vaccine-preventable disease mortality among children under five, despite the fact that a safe and efficacious vaccine is readily available7,8. Suspected measles cases counts were at a historic low in 2009, however in 2010, DRC saw a resurgence of measles cases with large-scale outbreaks affecting all 11 provinces7,8. These outbreaks are mainly attributed to gaps in routine immunization (RI) coverage, compounded with missed supplementary immunization activities (SIAs).

DRC’s EPI includes one dose of measles vaccine at 9 to 11 months of age followed by the second dose provided through “catch-up” campaigns for children age 6 months to 14 years, and rolling “follow-up” campaigns targeting children 6 to 59 months every three years7,9. Routine immunization remains sub-optimal, with World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) national coverage estimates placed at 73%, which is well below the recommended 90%8,10.

Population immunity to tetanus can be used as a proxy to determine the effectiveness of routine immunization due to the high fatality rate in cases (70%-90% fatal in neonatal tetanus) and the lack of natural immunity in those who recover11,12. Therefore, we would expect to see the presence of antibodies to tetanus at rates corresponding to reported vaccine coverage.

While rubella is currently not part of the routine immunization schedule in DRC, developing an understanding of the immunity profile of this disease will play an important role in policy for the addition of this antigen to the vaccination schedule.

Serosurveys measuring specific IgG antibodies are a direct and accurate method to assess population susceptibility and can provide critical insight into ongoing immunity gaps and operational program efficiency, although they are logistically challenging and expensive to undertake. As a result, they are generally limited to small geographic areas or convenience samples that may produce biased results and cannot be interpreted on a national scale.

We have therefore developed a first-of-its-kind collaboration with the DRC’s Demographic and Health Survey (DHS) to obtain robust, nationally representative estimates of population immunity to measles, mumps, rubella, varicella, and tetanus.

The objectives of this study were to 1) assess age-specific population immunity to vaccine-preventable diseases (measles, mumps, rubella, varicella, and tetanus) among children age 6 to 59 months

2

and 2) to identify risk factors associated with susceptibility to measles, mumps, rubella, varicella, and tetanus in children. The study was not designed to distinguish between vaccination and natural infection, but rather to determine the presence of immunity gaps. Whether these gaps are due to failure to vaccinate or vaccination failure cannot be assessed here.

The second Demographic and Health Survey in the Democratic Republic of Congo (EDS-RDC II) was designed to provide data for monitoring the population and health situation in DRC13. The EDS-RDC II provides reliable data on fertility; sexual activity; fertility preferences; knowledge and use of family planning; breastfeeding; the nutritional status of women and children under age five; childhood mortality; adult mortality (including maternal mortality); maternal and child health; HIV/AIDS and STI knowledge; and the use of mosquito nets to prevent malaria. Additionally, the survey included testing for HIV, anemia, malaria, and vaccine-preventable-diseases immunity (measles, mumps, rubella, varicella, and tetanus).

The EDS-RDC II was a nationwide, household based, multi-stage cluster survey. Fieldwork was completed from November 2013 to February 2014, and 18,171 households were successfully interviewed. In all, 18,827 women age 15 to 49 years in all selected households and 8,656 men age 15 to 59 years in 50% of selected households completed interviews. Children were eligible for biomarker data collection (height, weight, anemia, malaria, and vaccine-preventable disease serology) if the household had been selected for a man’s questionnaire and were age 6 to 59 months. Dried blood spots (DBS) were collected from participating children to assess population immunity to VPDs.

In total, 9,878 DBS were received and processed at the UCLA-DRC laboratory at the National Laboratory for Biomedical Research (INRB) in Kinshasa, DRC. Of these, 8,420 were from children age 6-59 months who were eligible for antibody testing. Laboratory testing was completed using the Dynex Technologies M²® multiplex Measles, Mumps, Rubella, Varicella, and Tetanus (MMRVT) immunoassay platform. Polystyrene beads coated separately with antigen to measles, mumps, rubella, varicella-zoster virus, and tetanus were immobilized within 54-well M² assay strips with 10 beads per well and processed using a modified Dynex DS2® automated ELISA system for IgG antibody detection. Assay cutoffs were set by reference to 3 singleplex and 1 multiplex FDA-approved ELISA kits, with a positive and negative control on each plate. Quantity control was performed in a 10% random subset of the samples at University of North Carolina, Chapel Hill on Luminex® xMAP® (multi-analyte profiling) technology platform.

SUMMARY OF RESULTS

• National measles seropositivity was 64.4%. The lowest seropositivity rates were seen in Kasai Occidental (53.6%), Maniema (52.0%), Kasai-Oriental (51.9%), and Katanga (51.4%) provinces.

• Overall tetanus seroprevalence was 36.0%. Provincial seropositivity estimates were lowest in Katanga (27.8%) and Maniema (20.1%). Large immunity gaps in both measles and tetanus are indicative of a weak routine immunization system.

• In the absence of a vaccine, rubella seropositivity was 34.4%. The high prevalence of circulating rubella virus in Bandundu (52.5%) and Bas-Congo (44.2%) suggest the need to evaluate immunization recommendations for rubella in DRC.

• National seroprevalence for both mumps and varicella is very low. For mumps, the overall seroprevalence is 22.0%, and is lowest in Équateur (13.2%) and Kasaï Oriental (18.3%). For varicella, the overall seroprevalence is just 9%, and is lowest in Équateur (3.9%) and Maniema (2.4%).

• Population immunity to VPDs varied widely by disease and province. Seropositivity rates were highest for measles suggestive of large-scale outbreaks that affect all 11 provinces.

3

• Seropositivity rates among the other VPDs were unexpectedly low, despite a 3-dose immunization schedule. This suggests the need for routine immunization system strengthening in DRC.

• There was also a lower-than-expected correlation between reported vaccination rates in the DHS and immunity to VPDs. Among those age 12-23 months who were reported to have been vaccinated against measles (either by a vaccination card or by the mother’s declaration), only 62.1% tested positive for the presence of measles antibodies. Among those 12-23 months who were reported to have had three doses of the pentavalent vaccine, only 57.5% tested positive for the presence of tetanus antibodies.

5

Table 1 Children 6 to 59 months (de facto) eligible for MMRVT antibody testing according to demographic characteristics (unweighted), Democratic Republic of Congo, 2013-2014

Sociodemographic characteristic % of children tested1

Number of eligible children

(6-59 months)1

Sex Male 95.3 4,183Female 95.4 4,237

Age (in months) 6-8 86.0 4809-11 95.5 44112-17 96.7 1,05118-23 95.7 79524-35 96.0 1,87236-47 96.2 1,91148-59 95.2 1,870

Area of residenceUrban 94.6 2,462Rural 95.7 5,958

Province Kinshasa 92.3 442Bas-Congo 96.1 382Bandundu 94.1 1,124Équateur 98.0 1,324Orientale 94.6 986Nord-Kivu 97.3 482Sud-Kivu 96.5 482Maniema 95.1 409Katanga 95.7 1,052Kasaï Oriental 92.7 1,003Kasaï Occidental 96.2 734

Total 95.4 8,420

1 Children with an available test result and identified in the questionnaire

Table 2 Results estimating the presence of measles antibodies

Distribution of children 6-59 months tested for the presence of measles antibodies, by demographics and test results, Democratic Republic of Congo, 2013-2014

Test results

Sociodemographic characteristic Positive Negative Indeterminate

Children age 6-59 months with a test

result

Sex Male 62.9 34.4 2.8 4,074 Female 66.0 31.9 2.1 4,043

Age category (in months) 6-8 18.3 81.1 0.6 414 9-11 40.9 57.2 1.9 463 12-23 54.3 42.9 2.8 1,767

12-17 51.0 46.7 2.3 998 18-23 58.6 37.9 3.5 769

24-35 66.5 32.1 1.3 1,851 36-47 74.8 22.0 3.2 1,792 48-59 78.4 18.5 3.0 1,830

Place of residence Urban 65.3 32.9 1.9 2,417 Rural 64.1 33.2 2.7 5,700

Province Kinshasa 75.8 22.5 1.7 535 Bas-Congo 59.3 37.2 3.4 338 Bandundu 59.8 39.0 1.2 1,336 Équateur 72.8 24.8 2.4 1,253 Orientale 76.0 21.2 2.7 806 Nord-Kivu 81.6 16.2 2.2 653 Sud-Kivu 69.4 26.5 4.0 593 Maniema 52.0 43.3 4.7 283 Katanga 51.4 46.5 2.1 835 Kasaï Oriental 51.9 45.9 2.2 875 Kasaï Occidental 53.6 43.1 3.4 609

Total 64.4 33.1 2.4 8,116

6

Table 3 Results estimating the presence of tetanus antibodies

Distribution of children 6-59 months tested for the presence of tetanus antibodies, by demographics and test results, Democratic Republic of Congo, 2013-2014

Test Results



result

Sex Male 35.1 63.2 1.7 4,074 Female 36.8 62.0 1.2 4,043


12-17 43.0 55.0 2.0 998 18-23 46.1 53.2 0.8 769

24-35 36.8 62.0 1.2 1,851 36-47 29.3 69.7 1.0 1,792 48-59 29.1 68.4 2.5 1,830



Total 36.0 62.6 1.4 8,116

Table 4 Results estimating the presence of rubella antibodies

Distribution of children 6-59 months tested for the presence of rubella antibodies, by demographics and test results, Democratic Republic of Congo, 2013-2014

Test Results



result

Sex Male 34.0 65.8 0.2 4,074 Female 34.8 65.1 0.1 4,043


12-17 25.9 74.0 0.0 998 18-23 27.4 72.5 0.1 769

24-35 32.7 67.1 0.2 1,851 36-47 37.7 62.2 0.1 1,792 48-59 47.6 52.3 0.1 1,830



Total 34.4 65.5 0.2 8,116

7

Table 5 Results estimating the presence of mumps antibodies

Distribution of children 6-59 months tested for the presence of mumps antibodies, by demographics and test results, Democratic Republic of Congo, 2013-2014

Test results



result

Sex Male 21.6 75.7 2.8 4,074 Female 22.4 74.0 3.6 4,043


12-17 12.8 84.6 2.5 998 18-23 17.8 79.9 2.3 769

24-35 21.0 76.5 2.5 1,851 36-47 26.4 69.7 3.9 1,792 48-59 32.0 63.3 4.8 1,830



Total 22.0 74.8 3.2 8,116

Table 6 Results estimating the presence of varicella antibodies

Distribution of children 6-59 months tested for the presence of varicella antibodies, by demographics and test results, Democratic Republic of Congo, 2013-2014

Test results



result

Sex Male 8.4 88.9 2.6 4,074 Female 9.6 88.8 1.6 4,043


12-17 5.2 94.3 0.5 998 18-23 6.9 92.4 0.7 769

24-35 9.1 88.9 2.1 1,851 36-47 9.9 87.5 2.6 1,792 48-59 13.5 83.2 3.3 1,830



Total 9.0 88.8 2.1 8,116

8

Table 7 Results of the test for the presence of measles antibodies and vaccination coverage among children 6-59 months

Distribution of children 6-59 months by the results of test for the presence of measles antibodies, by whether their vaccination card was seen during the survey or not, and by vaccination status, according to information collected in the survey, DemocraticRepublic of the Congo 2013-14

Vaccination card and vaccination coverage

Test results (measles) Children age 6-59 months with a test

result Positive Negative Indeterminate

GIRLS 6-59 MONTHS

Has vaccination card, seen during survey 63.9 33.9 2.2 710 Has vaccination card, not seen during survey 67.3 30.7 2.0 1,295 Does not have vaccination card 62.3 35.1 2.6 1,595

Vaccinated against measles (vaccination card) 73.6 23.8 2.6 547 Vaccinated against measles (mother’s declaration) 73.3 24.0 2.6 2,002 Vaccinated against measles (either source) 73.4 24.0 2.6 2,549 Not vaccinated against measles 42.9 55.6 1.5 1,069

Information not collected 73.7 25.7 0.6 412

Total 65.3 32.5 2.1 4,029

BOYS 6-59 MONTHS


Vaccinated against measles (vaccination card) 76.4 20.2 3.3 518 Vaccinated against measles (mother’s declaration) 68.5 28.3 3.1 2,049 Vaccinated against measles (either source) 70.1 26.7 3.2 2,567 Not vaccinated against measles 45.3 53.2 1.4 1,120


Total 63.6 33.7 2.7 4,087

TOTAL (BOYS AND GIRLS 6-59 MONTHS)

Has vaccination card, seen during survey 64.2 33.3 2.5 1,378 Has vaccination card, not seen during survey 65.7 31.9 2.5 2,703 Does not have vaccination card 61.4 36.1 2.5 3,197

Vaccinated against measles (vaccination card) 75.0 22.1 2.9 1,065 Vaccinated against measles (mother’s declaration) 70.9 26.2 2.9 4,051 Vaccinated against measles (either source) 71.7 25.4 2.9 5,116 Not vaccinated against measles 44.1 54.4 1.5 2,189


Total 64.4 33.1 2.4 8,116

9

Table 8 Results of the test for the presence of measles antibodies and vaccination coverage among children 12-23 months

Distribution of children 12-23 months by the results of test for the presence of measles antibodies, by whether their vaccination card was seen during the survey or not, and by vaccination status, according to information collected in the survey, Democratic Republic of the Congo 2013-14


Test results (measles) Children age 12-23 months

with a test result Positive Negative Indeterminate

GIRLS 12-23 MONTHS

Has vaccination card, seen during survey 68.1 28.3 3.6 217 Has vaccination card, not seen during survey 52.7 46.6 0.7 271 Does not have vaccination card 52.5 46.2 1.3 344

Vaccinated against measles (vaccination card) 71.9 24.0 4.1 189 Vaccinated against measles (mother’s declaration) 60.8 38.3 0.9 394 Vaccinated against measles (either source) 64.4 33.6 2.0 583 Not vaccinated against measles 38.4 60.6 1.0 249

Information not collected (76.4) (23.6) (0.0) 42

Total 57.6 40.8 1.6 874

BOYS 12-23 MONTHS


Vaccinated against measles (vaccination card) 66.2 29.4 4.4 173 Vaccinated against measles (mother’s declaration) 56.9 38.8 4.3 399 Vaccinated against measles (either source) 59.7 36.0 4.3 572 Not vaccinated against measles 35.0 63.4 1.7 294


Total 51.1 44.9 4.0 893



Vaccinated against measles (vaccination card) 69.2 26.6 4.3 362 Vaccinated against measles (mother’s declaration) 58.8 38.5 2.6 793 Vaccinated against measles (either source) 62.1 34.8 3.1 1,155 Not vaccinated against measles 36.6 62.1 1.4 543


Total 54.3 42.9 2.8 1,767

Note: Figures in parentheses are based on 25-49 unweighted cases.

10

Table 9 Results of the test for the presence of tetanus antibodies and vaccination coverage among children 6-59 months

Distribution of children 6-59 months by the results of test for the presence of tetanus antibodies, by whether their vaccination card was seen during the survey or not, and by vaccination status, according to information collected in the survey, Democratic Republic of the Congo 2013-14


Test results (tetanus) Children age 6-59 months with a test

result Positive Negative Indeterminate

GIRLS 6-59 MONTHS


Vaccinated against tetanus—first dose (vaccination card) 56.0 42.1 2.0 698 Vaccinated against tetanus—first dose (mother’s declaration) 39.4 59.5 1.1 2,188 Vaccinated against tetanus—first dose (either source) 43.4 55.3 1.3 2,887 Not vaccinated against tetanus 15.8 83.3 0.8 731

Vaccinated against tetanus—second dose (vaccination card) 56.7 41.2 2.0 669 Vaccinated against tetanus—second dose (mother’s declaration) 40.0 58.9 1.1 1,958 Vaccinated against tetanus—second dose (either source) 44.2 54.4 1.4 2,626 Not vaccinated against tetanus or second dose not received 20.9 78.3 0.8 991

Vaccinated against tetanus—third dose (vaccination card) 57.4 40.5 2.1 645 Vaccinated against tetanus—third dose (mother’s declaration) 40.4 58.5 1.1 1,541 Vaccinated against tetanus—third dose (either source) 45.4 53.2 1.4 2,186 Not vaccinated against tetanus or third dose not received 26.2 72.8 1.0 1,432


Total 36.8 62.0 1.2 4,029

BOYS 6-59 MONTHS


Vaccinated against tetanus—first dose (vaccination card) 56.8 40.2 3.1 649 Vaccinated against tetanus—first dose (mother’s declaration) 35.8 62.7 1.5 2,265 Vaccinated against tetanus—first dose (either source) 40.5 57.7 1.9 2,914 Not vaccinated against tetanus 15.4 83.6 1.0 773

Vaccinated against tetanus—second dose (vaccination card) 58.3 38.5 3.2 622 Vaccinated against tetanus—second dose (mother’s declaration) 36.7 61.6 1.7 2,035 Vaccinated against tetanus—second dose (either source) 41.8 56.2 2.0 2,657 Not vaccinated against tetanus or second dose not received 18.2 81.0 0.8 1,030

Vaccinated against tetanus—third dose (vaccination card) 59.1 37.6 3.3 601 Vaccinated against tetanus—third dose (mother’s declaration) 38.1 59.9 2.0 1,587 Vaccinated against tetanus—third dose (either source) 43.8 53.8 2.4 2,188 Not vaccinated against tetanus or third dose not received 22.6 76.7 0.6 1,499


Total 35.2 63.2 1.7 4,087


Has vaccination card, seen during survey 55.6 41.9 2.5 1,378 Has vaccination card, not seen during survey 37.8 60.8 1.4 2,703 Does not have vaccination card 27.4 71.5 1.1 3,197

Vaccinated against tetanus—first dose (vaccination card) 56.3 41.1 2.5 1,347 Vaccinated against tetanus—first dose (mother’s declaration) 37.6 61.1 1.3 4,454 Vaccinated against tetanus—first dose (either source) 41.9 56.5 1.6 5,801 Not vaccinated against tetanus 15.6 83.5 0.9 1,504

Vaccinated against tetanus—second dose (vaccination card) 57.5 39.9 2.6 1,291 Vaccinated against tetanus—second dose (mother’s declaration) 38.3 60.3 1.4 3,993 Vaccinated against tetanus—second dose (either source) 43.0 55.3 1.7 5,284 Not vaccinated against tetanus or second dose not received 19.5 79.7 0.8 2,021

Vaccinated against tetanus—third dose (vaccination card) 58.2 39.1 2.7 1,246 Vaccinated against tetanus—third dose (mother’s declaration) 39.2 59.2 1.6 3,128 Vaccinated against tetanus—third dose (either source) 44.6 53.5 1.9 4,374 Not vaccinated against tetanus or third dose not received 24.4 74.8 0.8 2,931


Total 36.0 62.6 1.4 8,116

11

Table 10 Results of the test for the presence of tetanus antibodies and vaccination coverage among children 12-23 months

Distribution of children 12-23 months by the results of test for the presence of tetanus antibodies, by whether their vaccination card was seen during the survey or not, and by vaccination status, according to information collected in the survey, Democratic Republic of the Congo 2013-14


Test results (tetanus) Children age

12-23 months with a test result Positive Negative Indeterminate

GIRLS 12-23 MONTHS


Vaccinated against tetanus—first dose (vaccination card) 69.4 27.2 3.3 215 Vaccinated against tetanus—first dose (mother’s declaration) 50.7 48.8 0.5 439 Vaccinated against tetanus—first dose (either source) 56.9 41.7 1.4 654 Not vaccinated against tetanus 21.5 78.0 0.5 178

Vaccinated against tetanus—second dose (vaccination card) 69.9 26.7 3.4 208 Vaccinated against tetanus—second dose (mother’s declaration) 50.4 49.3 0.3 390 Vaccinated against tetanus—second dose (either source) 57.2 41.5 1.4 598 Not vaccinated against tetanus or second dose not received 29.1 70.0 0.9 234

Vaccinated against tetanus—third dose (vaccination card) 71.0 25.5 3.6 200 Vaccinated against tetanus—third dose (mother’s declaration) 51.4 48.3 0.3 289 Vaccinated against tetanus—third dose (either source) 59.4 39.0 1.6 489 Not vaccinated against tetanus or third dose not received 34.9 64.4 0.7 343


Total 47.9 51.0 1.2 874

BOYS 12-23 MONTHS


Vaccinated against tetanus—first dose (vaccination card) 67.6 29.1 3.4 203 Vaccinated against tetanus—first dose (mother’s declaration) 41.8 57.2 0.9 467 Vaccinated against tetanus—first dose (either source) 49.6 48.7 1.7 670 Not vaccinated against tetanus 13.7 84.1 2.2 197

Vaccinated against tetanus—second dose (vaccination card) 69.0 27.5 3.5 198 Vaccinated against tetanus—second dose (mother’s declaration) 44.4 54.5 1.1 396 Vaccinated against tetanus—second dose (either source) 52.6 45.5 1.9 593 Not vaccinated against tetanus or second dose not received 17.4 81.0 1.6 273



Total 40.8 57.4 1.7 893



Vaccinated against tetanus—first dose (vaccination card) 68.5 28.1 3.4 418 Vaccinated against tetanus—first dose (mother’s declaration) 46.1 53.1 0.7 906 Vaccinated against tetanus—first dose (either source) 53.2 45.2 1.6 1,324 Not vaccinated against tetanus 17.4 81.2 1.4 375

Vaccinated against tetanus—second dose (vaccination card) 69.4 27.1 3.5 406 Vaccinated against tetanus—second dose (mother’s declaration) 47.4 51.9 0.7 786 Vaccinated against tetanus—second dose (either source) 54.9 43.5 1.6 1,192 Not vaccinated against tetanus or second dose not received 22.8 75.9 1.3 507



Total 44.3 54.2 1.5 1,767

Note: Figures in parentheses are based on 25-49 unweighted cases.

13

REFERENCES

1. WHO. DRC SIA Administrative Data. Kinshasa. 2012.

2. Immunization profile – Democratic Republic of Congo. World Health Organization; 2008. http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm. Accessed January 20, 2012.

3. Independent Monitoring Board of the Global Polio Eradication Initiative. Ten months and counting: IMB; 2012.

4. Murray CJ, Shengelia B, Gupta N, Moussavi S, Tandon A, Thieren M. Validity of reported vaccination coverage in 45 countries. Lancet. Sep 27 2003;362(9389):1022-1027.

5. Valadez JJ, Weld LH. Maternal recall error of child vaccination status in a developing nation. Am J Public Health. Jan 1992;82(1):120-122.

6. MdlSRDdC. Etude de Couverture Vaccinale en RDC. Kinshasa: Kinshasa School of Public Health; 2012.

7. World Health Organization, 2012. Status Report on Progress Towards Measles and Rubella Elimination.

8. Programme Elargi De Vaccination, 2012. Plan Stratégique d'élimination de la Rougeole en RDC: 2012-2020. Democratic Republic of Congo.

9. Masresha BK, R.; Eshetu, M.; Katsande, R.; Luce, R.; Fall, A.; Dosseh, A.; Boubker, N.; Byabamazima, CR.; Perry, R.; Dabbagh, AJ.; Strebel, P.; Kretsinger, K.; Goodson, JL.; Nshimirimana, D., 2014. Progress toward Measles Preelimination - Africa Region, 2011-2012. Morbidity and Mortality Weekly 63: 285-291.

10. United Nations Children's Fund, 2013. Towards a World without Measles and Rubella. Available at: http://www.unicef.org/immunization/index_measles.html.

11. Independent Monitoring Board of the Global Polio Eradication Initiative. Ten months and counting: IMB;2012.

12. Ministère du Plan et Macro International. 2008. Enquête Démographique et de Santé, République Démocratique du Congo 2007. Calverton, Maryland, U.S.A. : Ministère du Plan et Macro International.

13. Ministère du Plan et Suivi de la Mise en Oeuvre de la Révolution de la Modernité (MPSMRM), Ministère de la Santé Publique (MSP) et ICF International, 2014. Enquête Démographique et de Santé en République Démocratique du Congo 2013-2014. Rockville, Maryland, USA : MPSMRM, MSP, et ICF International.

democratic republic of the congo · in the democratic republic of congo (drc), results from a...

Documents